(CNN)Being a nurse means everything to Andrea Babinski, but she is willing to risk it all -- the connections to colleagues she likes, the patients she cares for, not to mention the steady paycheck -- for a simple belief.
Babinski believes that the decision of whether she should get vaccinated against Covid-19 should be a personal medical choice. So far, she has chosen not to be vaccinated.
She says she's not anti-vaccine, or against the Covid-19 vaccine. She encouraged her father to get one.
And she has worked all through the pandemic, in layers of PPE, and been floated to the Covid unit, where she saw firsthand how devastating it can be some patients.
And still, she believes the vaccine isn't the best option for her, and it should be her choice alone whether to get it.
Her hospital in La Crosse, Wisconsin, doesn't see it that way.
Her hospital in La Crosse, Wisconsin, doesn't see it that way.
To the Gundersen Health System, and many other hospitals instituting mandates, the Covid-19 vaccine is important for safety reasons. It protects the workers. It protects the patients. It protects the hospital by keeping staff healthy enough to stay on the job.
If Babinski does not choose to get the vaccine by November 1, she may be fired. She may not even be eligible for unemployment.
"You know when you put your heart and soul into a job for this long, as I have, it's really a hard blow to just all of the sudden hear you're going to get fired," Babinski said.
Mandates and health care systems
It's not clear how many health care workers aren't yet vaccinated against Covid-19. There's no national vaccine registry or other resource tracking exactly how many health care professionals have or have not gotten the shot.
There are indications that compliance is high; many health care professional associations have surveyed members and the majority said they are already vaccinated. These surveys have limits. They capture just a fraction of people's opinions in the field, and the methodology isn't always clear.
What is clear is that these professional associations already back mandates. And with more mandates coming, it appears more health care professionals will decide to get vaccinated.
About 92% of hospital staff in New York, for instance, have received at least one dose, the governor's office said Tuesday. Those numbers increased considerably over the last four weeks as the deadline to be vaccinated loomed. Gov. Kathy Hochul said said Thursday that no facilities have closed because of staff shortages.
Still, hundreds of unvaccinated workers in New York were suspended, and vaccine holdouts caused some disruptions, especially upstate.
At the Erie County Medical Center Corporation in Buffalo, New York, 7% of the workforce was put on administrative leave because they were not vaccinated. They had to stop accepting ICU transfers, and reduced clinic hours and units at a long-term care facility.
Earlier in September, 30 employees in another hospital in upstate New York quit before the mandate. It had to "pause" delivering babies because it no longer had enough staff members.
It's such a concern, Hochul signed an executive order Monday to expand the available health care workforce to address potential shortages.
What's happened in New York may be repeated in other states as mandate deadlines loom.
Thursday was California's deadline for workers at health facilities to have at least a first dose; many large hospital systems there have said the majority of their staffs were vaccinated even when mandates were announced, and they anticipated more would be.
But there are already reports of staff quitting or being fired at hospitals in Texas, Pennsylvania, South Carolina, North Carolina, Kentucky, Indiana, New Jersey, Virginia, Maine, and Maryland, according to Becker's Hospital Review.
Alan Morgan, the head of the Rural Health Association, said he expects service disruptions at some of his member hospitals; some told him that 40% of their workers are not vaccinated.
"Even if you get down to 2 to 5% that decide to leave their job, in small facilities that's an issue," Morgan said. "That's going to create service delivery disruptions and in these small rural hospitals, they just don't have the flexibility of larger health systems."
The coming new rule change
But the Biden administration thinks mandates are worth the risk to end the pandemic.
Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said Monday that the "vast majority" of the country will likely need to become vaccinated to control the spread.
Earlier in September Fauci said "many, many mandates" will be necessary. "You'd like to have them do it on a totally voluntary basis, but if that doesn't work, you've got to go to the alternatives," he told CNN.
The Biden administration announced this month that it will require all staff at all Medicare and Medicaid-certified facilities -- the majority of health care facilities -- to get a Covid-19 vaccine. The regulation applies to workers at hospitals, dialysis facilities, surgical centers, home health care workers, nursing homes and more -- around 50,000 facilities in all.
The Biden administration announced this month that it will require all staff at all Medicare and Medicaid-certified facilities -- the majority of health care facilities -- to get a Covid-19 vaccine. The regulation applies to workers at hospitals, dialysis facilities, surgical centers, home health care workers, nursing homes and more -- around 50,000 facilities in all.
"There is no question that staff, across any health care setting, who remain unvaccinated pose both direct and indirect threats to patient safety and population health," US Health and Human Services Secretary Xavier Becerra said when the Biden administration made the announcement.
Studies have shown that nursing homes with vaccination rates 75% or lower have higher rates of preventable Covid-19 outbreaks, according to HHS.
Whether medical personnel are vaccinated can also influence patients who may be on the fence and want to ask their advice, the experts say. Nurses, especially, matter, said Mary Lou Manning, a nurse and professor at Thomas Jefferson University.
At 4 million, nurses make up the largest sector of the health care workforce. "We're in every facet of health care so the influence of nurses and helping people to decide to receive vaccine or not, is really important," Manning said.
After seeing firsthand what Covid-19 can do to a person, Manning said she was surprised at first some nurses were still reluctant.
"But I guess when I think about it, I think of these 4 million (nurses) are kind of a microcosm of the greater population," she said. "The difference is the influence and reach of nurses."
CMS is still developing the new rule about the mandate. It won't likely be issued until some time in October, but some hospital systems like Gundersen in Wisconsin didn't wait. It announced its mandate in August.
At the time, about 85% of its staff had received their Covid-19 vaccine, the hospital said.
Babinski is not one of them.
A personal medical choice
Babinski said repeatedly she is not anti-vaccine or anti-Covid-19 vaccine. She said she doesn't believe in crazy conspiracy theories or have political or religious objections.
She simply believes this should be a personal medical decision, and she doesn't feel ready to do it yet. She doesn't think there should be a mandate, and she still has enough questions about the research and whether the vaccine is right for her that she does not want to get it.
"As a nurse, for our entire career, we always respect a patient's choice for informed consent and refusal of whatever medical treatments and medication," Babinski said. "If a patient does not want them, it doesn't matter what their family, or anyone else says.
"It's your body, and in the end you're the only one responsible for it."
Each unvaccinated person she talked to at work seem to have different reasons for their hesitancy.
Babinski says she's concerned what the vaccine could do to her health. She has a couple of autoimmune diseases and clotting disorders.
"I just feel like at this point there is not enough research," said Babinski. "I'm concerned about putting another kind of trigger into my body that could make you have a flare up."
Research shows a small risk of an unusual blood clotting reaction with Johnson & Johnson's vaccine, but not with the vaccines made by Moderna or Pfizer. Studies have not shown people with blood clotting disorders are any more prone to the reaction seen with the J&J vaccine.
"In my opinion, we should not be vaccinating at mass scale at this point, because then it's harder to track or know if there are harmful things that are happening right now or affecting certain groups of people," Babinski said. "Nobody can really guarantee one way or the other whether there's anything harmful or whether there is not."
But nearly 200 million American adults have had at least one dose of one of the three authorized Covid-19 vaccines, and serious side effects that could cause long-term health problems are "extremely unlikely," according to the CDC.
Common side effects are a sore arm, tiredness, headache, chills, but disappear quickly. CDC's safety monitoring systems have found two serious types of health problems after vaccination, both of which are rare -- anaphylaxis, and the rare blood clotting event after vaccination with the Johnson & Johnson vaccine.
Babinski, though, still wants to be cautious -- although immunocompromised people can face greater risks of severe disease or death from Covid-19.
Babinski and her colleagues have held rallies outside the hospital to protest the mandate. Colleagues held signs that said "Heroes get fired here", "No Jab? No Job? No Justice!" and "My body my choice."
When CNN Chief Medical Correspondent Dr. Sanjay Gupta spoke with Babinski, he pressed her on whether she would ever get the vaccine.
"Not at this point, but -- " she said. "I mean, never say never."
Consequences for workers and hospitals
Babinski's colleague, David Anderson, a nurse on the night shift in patient psychiatry, has worked many long hours and seen what Covid-19 can do to patients, but after November 1, he's not sure if he'll be at Gundersen. He thinks mandates are unfair.
"It's so coercive to hold this over people's heads, to try and convince them to get a vaccine that, for their own personal reasons they've decided is not right for them," Anderson said. "I find the mandate unacceptable and really unfortunate, and it will have long-term consequences."
Anderson and Babinski say they've known people who have quit already.
"The staff whose jobs are on the chopping block because of this bring thousands of years of direct patient care experience," Anderson said.
Anderson said he doesn't want to get the vaccine for a few reasons. In part, because he doesn't think there's enough independent research.
He says he lost trust in pharmaceutical research back when he was a first responder and witnessed the ravages of the opioid epidemic.
"I guess there are red flags there for just kind of blindly trusting what the pharmaceutical companies are telling us," Anderson said. "I'm not saying that I'm positive vaccines are hurting people, or anything like that, and I certainly acknowledge that you need to be protecting the vulnerable and keeping them out of hospital beds. I think the data on that is clear, but there are so many barriers being put up to even collecting data (about effects of vaccines)."
There is one thing that would change his mind about the vaccine.
"If we had a vaccine that actually prevented transmission, I would be first in line to get it," Anderson said. "I'm inoculated against measles, and I don't get measles and I don't give it to patients. That's not true for the Covid vaccine."
The CDC says being vaccinated against coronavirus reduces the likelihood a person will be infected -- and people who are not infected do not spread the virus.
The vaccine also provides strong protection against severe disease or death. The unvaccinated are 11 times more likely to die and 10 times more likely to be hospitalized with Covid-19, according to the CDC.
A vaccinated person who becomes infected, even with the highly contagious Delta variant, is less likely to spread it than an unvaccinated person, but more studies are needed to show just how likely a vaccinated person it to transmit virus, the agency says.
But even before the more contagious variant became dominant strain in the United States, even as he worked with Covid-19 patients and put himself at risk for getting sick, Anderson said still wasn't leaning toward getting it. He said there were just too many questions.
What would convince them?
It's unclear how many at Gundersen are like Babinski and Anderson. Babinski said the Facebook page against the mandate has about 600 employees on it. It's also not clear what would convince them before the deadline to choose between their jobs and the vaccine.
Eileen Sullivan-Marx, the dean at the New York University Rory Meyers School of Nursing and the president of the American Academy of Nursing, said some health care facilities have seen less hesitancy if they take the time to debunk myths and educate.
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"Digging deep into appealing to the professional nurses' commitment, and oftentimes high levels of devotion, versus their identity as to where this vaccine is, and it usually takes a lot of conversations to get through that hesitancy," Sulivan-Marx said.
April Kapu, president of the American Association of Nurse Practitioners, said she hopes health care systems continue to work with health professionals to overcome their hesitancy.
"We need every single nurse," Kapu said. "The nurses is a person, just like anyone else, then we need to understand their concerns and address those concerns."
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